Have you ever been diagnosed with an acoustic neuroma (or vestibular schwannoma) by a physician or health care professional?
Yes
No
Uncertain
Decline to answer
Have you had a first-degree relative (sibling, parent, child) with a diagnosis of acoustic neuroma?
Yes
No
Have you had a second-degree relative (aunt/uncle, niece/nephew, grandparent, grandchild, half-sibling) with a diagnosis of acoustic neuroma?
Yes
No
If you know one or more people, not indicated above, who have been diagnosed with acoustic neuroma, please identify your relationship here. Otherwise, leave this field blank.
Were you ever diagnosed with a second acoustic neuroma? (Not including a recurrent tumor after treatment.)
No
Yes, on the same side as the first
Yes, on the opposite side as the first
Not sure
Which side was your acoustic neuroma diagnosed on?
Right
Left
Both
Unsure
If you were referred to this study by someone with Acoustic Neuroma, please write THEIR full name here.
Have you ever been diagnosed with Neurofibromatosis, Type II (NF2) by a physician or health care professional?
Yes
No
Uncertain
Decline to answer
Please write your age at the time of diagnosis with acoustic neuroma. (E.g. "45")
Please mark the date when you were first diagnosed with acoustic neuroma. If you are unsure, please provide your best guess.
M-D-Y
Did you undergo a brain scan which resulted in your diagnosis of acoustic neuroma? (MRI, CT, "Cat Scan", etc.)
Yes No Unsure / I do not recall
At the time of your FIRST brain scan which showed acoustic neuroma, what was the size of your tumor, in the largest dimension?
Please write your tumor size in millimeters. (1 cm = 10 mm)
Was your tumor discovered incidentally?
Yes No
Across the lifetime of your tumor, did it undergo any GROWTH or change in size?
Yes
No
Uncertain
After your initial brain scan, did you undergo another brain scan at a later date?
Yes No Unsure / I do not recall
Please mark the approximate date of this SECOND brain scan.
M-D-Y
Approximately how long after your diagnosis of acoustic neuroma did you get this SECOND scan?
Less than 2 weeks 2 to 4 weeks 1 to 2 months 2 to 4 months 4 to 6 months 6 to 8 months 8 months to 12 months 12 months to 18 months 18 months to 24 months 2 to 3 years 3 to 5 years More than 5 years Uncertain / I do not recall
At this second scan, did your tumor show any signs of growth?
Yes No Unsure
At the time of your SECOND brain scan which showed acoustic neuroma, what was the size of your tumor in the largest dimension?
After your SECOND brain scan, did you undergo any additional subsequent brain scans to monitor the growth of the acoustic neuroma?
Yes No Unsure / I do not recall
Please list the dates of each subsequent brain scan (prior to surgical resection, if applicable), along with the size (in mm) of the tumor recorded at the time. If you are unsure of the size of the tumor, please state if there was 'growth' or 'no growth'.
Did you experience any SYMPTOMS* as a result of your acoustic neuroma?
Yes No Uncertain
What was the FIRST presenting symptom that you had from your acoustic neuroma?
You indicated "Other" in the previous question. Please write your symptom here as concisely as possible.
Please record the approximate date that you initially experienced your FIRST symptom(s). If you are unable to recall, please leave this field blank.
M-D-Y
Approximately how long after experiencing this FIRST symptom did you receive your diagnosis of acoustic neuroma?
Less than 2 weeks 2 to 4 weeks 1 to 2 months 2 to 4 months 4 to 6 months 6 months to 1 year 1 to 2 years 2 to 4 years More than 5 years This symptom presented AFTER I was diagnosed Uncertain / I do not recall
Did you experience any ADDITIONAL symptoms from your acoustic neuroma?
Yes
No
Uncertain
What was the SECOND presenting symptom, or set of symptoms, that you had from your acoustic neuroma?
You indicated "Other" in the previous question. Please write your symptom here.
Please record the approximate date that you initially experienced your SECOND symptom(s). If you are unable to recall, please leave this field blank.
M-D-Y
Approximately how long after experiencing this SECOND symptom did you receive your diagnosis of acoustic neuroma?
Less than 2 weeks 2 to 4 weeks 1 to 2 months 2 to 4 months 4 to 6 months 6 months to 1 year 1 to 2 years 2 to 4 years More than 5 years This symptom presented AFTER I was diagnosed Uncertain / I do not recall
Did you experience any ADDITIONAL symptoms from your acoustic neuroma?
Yes
No
Uncertain
What was the THIRD presenting symptom, or set of symptoms, that you had from your acoustic neuroma?
You indicated "Other" in the previous question. Please write your symptom here.
Please record the date that you initially experienced your THIRD symptom(s). If you are unable to recall, please leave this field blank.
M-D-Y
Approximately how long after experiencing this THIRD symptom did you receive your diagnosis of acoustic neuroma?
Less than 2 weeks 2 to 4 weeks 1 to 2 months 2 to 4 months 4 to 6 months 6 months to 1 year 1 to 2 years 2 to 4 years More than 5 years This symptom presented AFTER I was diagnosed Uncertain / I do not recall
Did you experience any ADDITIONAL symptoms from your acoustic neuroma?
Yes
No
Uncertain
Please mark any ADDITIONAL symptoms which you experienced from your acoustic neuroma, not otherwise indicated above.
PROGRESS CHECK:
Have you ever experienced a SUDDEN DECLINE IN HEARING on the side of the tumor?
Yes
No
Did this SUDDEN hearing loss occur prior to any surgical treatment?
Yes
No
After you had the sudden hearing loss, how much time passed before you were seen by a health care professional to have the hearing evaluated?
2 weeks or less
>2 weeks, but not more than 4 weeks
1-2 months
3-6 months
7-12 months
>12 months
If you experienced SUDDEN HEARING LOSS on the side of the tumor, did you receive steroids for treatment of the hearing loss? (e.g., prednisone, dexamethasone, solumedrol)
Yes
No
How much time passed between the first day of sudden hearing loss and the day you started taking steroids?
2 weeks or less
>2 weeks, but not more than 4 weeks
1-2 months
3-6 months
More than 6 months
If you received steroids for sudden hearing loss on the side of the tumor, how were the steroids administered?
By mouth
Through the eardrum
Both by mouth AND through the eardrum
Injection
Other method of administration
If you received steroids for sudden hearing loss on the side of the tumor, how did the hearing recover?
None
Partially
Fully
If you experienced sudden hearing loss on the side of the tumor, but DID NOT receive steroids, how did the hearing recover?
None
Partially
Fully
Did you undergo a hearing test to assess how your hearing recovered or did not recover?
Yes
No
Which treatment(s) did you receive for your diagnosis of acoustic neuroma?
Please write in the 'other' treatment you received.
Please mark the date (or nearest approximation) of your first acoustic neuroma radiation therapy (Gamma knife / radiosurgery / etc.)
M-D-Y
How many times did you undergo radiosurgery (Gamma knife / SRS / etc.)?
1 2 3 4 5 6 7 8 9 10 or more
Please mark the date (or nearest approximation) of your first acoustic neuroma surgery.
M-D-Y
Did you have a recurrent / second incidence of acoustic neuroma ON THE SAME SIDE after undergoing surgical resection?
No
Yes
Please indicate the MOST SIGNIFICANT factor in guiding your treatment decision.
My age
Family / friends
Insurance issues (coverage)
Out of Pocket Cost ($)
Physician/Surgeon Accessibility/Reachability
Physician/Surgeon Appointment Availability
Physician/Surgeon Expertise/Recommendations
Preference for University/Academic Affiliated Hospital
Risk of Complication/Treatment Side Effects
Religious beliefs
Severity of your pre-treatment symptoms
Surgeon Experience
Surgical or Radiation Therapy Approach (Retrosigmoid, Middle Fossa, Translabyrinthine, Gamma knife / SRS / radiosurgery, etc.)
Time away from work
Travel/Distance to care provider
Trust in your Surgeon
Tumor Size
Tumor Growth Rate
Concerns over preservation of hearing
Other - Please specify concisely
Please state concisely the MOST SIGNIFICANT factor guiding your treatment decision, if not already listed above in the previous question.
